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The physician’s psychoactive medication resource guide
25% of your patients taking an antidepressant will have
weight gain and the weight gain is directly caused by the antidepressant.
Brand name (Desyrel)
Trazodone - Desyrel. Trazodone - Desyrel side effects, warnings, precautions, adverse
effects, overdose and withdrawal symptoms. Trazodone - Desyrel natural alternatives.
Before you begin the spiral down with these drugs, try giving your body what it really
Trazodone is a psychoactive compound with sedative and anti-depressant properties. Its
mechanism of action in humans is not clear.
Trazodone is well absorbed after oral administration with mean peak plasma levels obtained
within 0.5 to 2 hours after ingestion. Absorption is somewhat delayed and enhanced by food.
The mean plasma elimination half-life is 4.4 hours for the period from 3 to 10 hours after dosing,
and 7 to 8 hours for the period from 10 to 34 hours. The drug is extensively metabolized with 3
or 4 major metabolites having been identified in man. Approximately 60 to 70% of C14-labelled
trazodone was found to be excreted in the urine within 2 days and 9 to 29% in feces over 60 to
100 hours. Trazodone is 89 to 95% protein bound in vitro at concentrations attained with
For the symptomatic relief of depressive illness.
Known hypersensitivity to trazodone.
Trazodone has been associated with the occurrence of priapism. In approximately 33% of the
cases reported, surgical intervention was required and, in a portion of these cases, permanent
impairment of erectile function or impotence resulted. Male patients with prolonged or
inappropriate erections should immediately discontinue the drug and consult their physician. If
the condition persists for more than 24 hours, it would be advisable for the treating physician to
consult a urologist or appropriate specialist in order to decide on a management approach.
Recent clinical studies in patients with pre-existing cardiac disease indicate that trazodone may
be arrhythmogenic in some patients in that population. Arrhythmias identified include isolated
PVC's, ventricular couplets, and in 2 patients short episodes (3 to 4 beats) of ventricular
tachycardia. There have also been several post-marketing reports of arrhythmias in trazodone-
treated patients who have pre-existing cardiac disease and in some patients who did not have
pre-existing cardiac disease. Until the results of prospective studies are available, patients with
pre-existing cardiac disease should be closely monitored, particularly for cardiac arrhythmias.
Trazodone is not recommended for use during the initial recovery phase of myocardial
The possibility of suicide in depressed patients remains during treatment and until significant
remission occurs. Therefore, the number of tablets prescribed at any one time should take into
account this possibility, and patients with suicide ideation should never have access to large
quantities of trazodone.
Episodes of grand mal seizures have been reported in a small number of patients. The majority
of these patients were already receiving anticonvulsant therapy for a previously diagnosed
Since trazodone may impair the mental and/or physical abilities required for performance of
potentially hazardous tasks, such as operating an automobile or machinery, the patient should be cautioned not to engage in such
activities while impaired.
Trazodone may enhance the response to alcohol and the effects of barbiturates and other CNS depressants and patients should be
Increased serum digoxin and phenytoin levels have been reported to occur in patients receiving trazodone concurrently with either of
those 2 drugs. Little is known about the interaction between trazodone and general anesthetics; therefore, prior to elective surgery,
trazodone should be discontinued for as long as clinically feasible.
Because it is not known whether an interaction will occur between trazodone and MAO inhibitors, administration of trazodone should
be initiated very cautiously with gradual increase in dosage as required, if an MAO inhibitor is given concomitantly or has been
discontinued shortly before medication with trazodone is instituted.
Trazodone may cause hypotension including orthostatic hypotension and syncope; caution is required if it is given to patients receiving
antihypertensive drugs and an adjustment in the dose of the antihypertensive medication may be required.
Because of the absence of experience, concurrent administration of electro-shock therapy should be avoided.
Pregnancy and Lactation:
Since the safety and use of trazodone in pregnant women has not been established, it should not be used in women of childbearing
potential unless in the opinion of the physician the expected benefits justify the potential risk to the fetus. Since trazodone and/or its
metabolites have been detected in the milk of lactating animals, it should not be administered to nursing mothers unless the potential
benefits justify the possible risks to the child.
The safety and effectiveness of trazodone in children below the age of 18 have not been established.
It is recommended that white blood cell and differential counts should be performed in patients who develop sore throat, fever, or other
signs of infection or blood dyscrasia and trazodone should be discontinued if the white blood cell or absolute neutrophil count falls
Hyperprolactinemia and breast tumors:
There is sufficient experimental evidence to conclude that chronic administration of those psychotropic drugs, such as trazodone,
which increase prolactin secretion has the potential to induce mammary neoplasms in rodents under appropriate conditions. Tissue
culture experiments indicate that approximately 33% of human breast cancers are prolactin dependent in vitro, a factor of potential
importance if the prescription of these drugs is contemplated in a patient with a previously detected breast cancer. Although
disturbances such as galactorrhea, amenorrhea, gynecomastia and impotence have been reported, the clinical significance of elevated
serum prolactin levels or increased secretion and turnover are unknown for most patients. Neither clinical studies nor epidemiological
studies conducted to date, however, have shown an association between administration of these drugs and mammary tumorigenesis:
Available evidence is considered too limited to be conclusive at this time.
The most common adverse reactions encountered are drowsiness, nausea/vomiting, headache and dry mouth. Adverse reactions
reported include the following:
Drowsiness, fatigue, lethargy, retardation, lightheadedness, dizziness, difficulty in concentration, confusion, impaired memory,
disorientation, excitement, agitation, anxiety, tension, nervousness, restlessness, insomnia, nightmares, anger, hostility and, rarely,
hypomania, visual distortions, hallucinations, delusions and paranoia.
Tremor, headache, ataxia, akathisia, muscle stiffness, slurred speech, retarded speech, vertigo, tinnitus, tingling of extremities,
paresthesia, weakness, grand mal seizures (see Precautions), and, rarely impaired speech, muscle twitching, numbness, dystonia and
Dry mouth, blurred vision, diplopia, miosis, nasal congestion, constipation, sweating, urinary retention, increased urinary frequency and
Orthostatic hypotension, hypertension, tachycardia, palpitations, shortness of breath, apnea, syncope, arrhythmias, prolonged P-R
interval, atrial fibrillation, bradycardia, ventricular ectopic activity (including ventricular tachycardia), myocardial infarction and cardiac
Nausea, vomiting, diarrhea, gastrointestinal discomfort, anorexia, increased appetite.
Priapism, decrease and, more rarely, increase in libido, weight gain and loss, and rarely, menstrual irregularities, retrograde ejaculation
and inhibition of ejaculation.
Allergic or toxic:
Skin rash, itching, edema, and, rarely, hemolytic anemia, methemoglobinemia, liver enzyme alterations, obstructive jaundice,
leukocytoblastic vasculitis, purpuric maculopapular eruptions, photosensitivity and fever.
Aching joints and muscles, peculiar taste, hypersalivation, chest pain, hematuria, red, tired and itchy eyes.
Overdosage of trazodone may cause an increase in incidence or severity of any of the reported adverse reactions, e.g. hypotension
and excessive sedation. In one known suicide attempt, the patient presented with symptoms of drowsiness and weakness 3 hours after
ingesting 7.5 g (12.5 times the maximum daily dose) of trazodone. Recovery was uneventful. Death by deliberate or accidental
overdosage has not been reported.
There is no specific antidote for trazodone. Management of overdosage should, therefore, be symptomatic and supportive. Any patient
suspected of having taken an overdosage should be admitted to hospital as soon as possible and the stomach emptied by gastric
lavage. Forced diuresis may be useful in facilitating elimination of the drug.
Dosage should be initiated at a low level and increased gradually noting carefully the clinical response and any evidence of
intolerance. It should be kept in mind that there may be a lag in the therapeutic response. Increasing the dosage rapidly does not
normally shorten this latent period and may increase the incidence of side effects.
Usual adult dosage:
The recommended initial dose is 150 to 200 mg daily, in 2 or 3 divided doses. Trazodone should be taken shortly after a meal or light
snack in order to reduce the incidence of adverse reactions. The initial dose may be increased according to tolerance and response by
increments of 50 mg, usually up to 300 mg daily in divided doses. In some patients, doses up to 400 mg daily and rarely up to 600 mg
daily in hospitalized patients, may be required. Occurrence of drowsiness may require the administration of a major portion of the daily
dose at bedtime or a reduction of dosage. Once an adequate response has been achieved, the dosage may be gradually reduced, with
adjustment depending on therapeutic response. During prolonged maintenance therapy the dosage should be kept at the lowest
Use in the elderly:
If used in the elderly, doses not exceeding one-half the recommended adult dosage should be used, with adjustments made depending
on tolerance and response.
Because safety and effectiveness in children have not been established trazodone is not recommended in the pediatric age group.
Each orange, round, film-sealed, scored tablet contains: Trazodone hydrochloride 50 mg. Bottles of 100 and 250.
Each white, round, film-sealed, scored tablet contains: Trazodone hydrochloride 100 mg. Bottles of 100.
Each orange rectangular-shaped, trisected and bisected tablet contains: Trazodone hydrochloride 150 mg. Each tablet can be broken
accurately to provide any of the following dosages: 50 mg (1/3 tablet), 75 mg (1/2 of a tablet), 100 mg (2/3 of a tablet), 150 mg (entire
tablet). To break a Dividose tablet accurately and easily, hold the tablet between your thumbs and index fingers, close to the
appropriate score (groove). Then with the tablet score facing you, apply pressure and snap the tablet segments apart. Bottles of 100.